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Full text of "Rapid Population Growth Consequences And Policy Implications"

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pated in the next 20 years. Nevertheless, pressures to approach MDC levels of personal health services will persist, and demand for piped water and proper waste disposal will probably increase. Investment in natality control measures above their present low levels can be expected as the effects of high population growth rates are felt.
Second are national decisions made regarding the kinds of health service functions that are best performed by different kinds of health personnel. (Which services during pregnancy can be performed by a midwife and which require a doctor? Who is qualified to insert an intra-uterine device or prescribe oral contraceptives or perform an abortion? What proportion of doctors should be women?) Decisions on these matters by LDC's should differ from those by MDC's, just as the cultures and illness patterns and educational facilities differ.
The criterion of a program's applicability to agricultural village life will remain a dominant consideration for a long time. In a speech (unpublished) at the 1969 World Health Assembly in Boston, WHO Director-General M.G. Candau said,
. . . the developing nations must not blindly follow old patterns but should design their educational systems to meet their own different health needs. In doing so they must bear in mind the need for re-examining the allocation of responsibility to various members of the health team. Physicians in all countries could be used to better advantage if they were relieved of functions that could be carried out by other members of the team. By this means it should be possible to ameliorate, at least in part, the critical situation of the developing countries where, for at least a generation, there is no possibility of providing enough physicians to carry out all their traditional functions.
Third are world technologic developments. These are the least predictable and most likely to produce profound changes within 20 years. Their overall effect is to accelerate acllievement of goals beyond those possible with present technology. However, improper overemphasis on the products of technology can impede progress toward goals; every hospital does not need a heart-lung machine. Because of the great difficulty of prediction, probable improvements in contraceptive technology are not taken into further account here beyond serving as a safety factor for other assumptions.
Fourth are levels of international technical assistance. Since World War II, health assistance has been sizeable through the World Health Organization, the U.S. Agency for International Development, and other governmental and private sources. Except for a few private sources and one small nation-Sweden—technical assistance in family planning was virtually nonexistent before 1965 (27). At recent rates of increase, technical assistance should be substantial over the next 20 years in both health and family planning.y and morbidity control is antici-into account the varying medical and cultural